Posterior Cervical Fusion

The neck may need stabilising for several reasons: instability from degeneration, inflammation or previous surgery; deformity such as the neck bending forward; or the need to secure the spine after decompressing the cord across multiple levels. In each case, holding the vertebrae in good alignment allows the spine to fuse solidly, protecting the cord and relieving the mechanical problem. Posterior cervical fusion is frequently combined with decompression when both pressure relief and stabilisation are required.

The operation is carried out through an incision at the back of the neck. Screws are placed into strong parts of the vertebrae — commonly the lateral masses in the mid-neck and the pedicles at certain levels — and connected by rods that hold the spine in the desired alignment. Where the cord also needs decompressing, the bony arches and any thickened ligament are removed at the same time. Bone graft is applied so that, over the following months, the instrumented segments knit into a solid fusion, with the metalwork providing stability while this occurs.

Posterior cervical fusion can be considered for cervical instability, for deformity requiring correction or prevention, and to stabilise the spine when a multilevel posterior decompression is performed. It is often chosen where several levels are involved, where alignment is a concern, or where strong fixation is needed. The choice between a posterior fusion, an anterior operation, or a combined approach depends on where the problem lies, the alignment of the neck, the number of levels, and the individual. The decision is individualised.

The evidence supports posterior cervical fusion, particularly in combination with decompression, for suitable multilevel and unstable problems. Comparative reviews of laminectomy with fusion against laminoplasty, and of posterior against anterior approaches for myelopathy, show that fusion-based posterior surgery achieves good neurological improvement and reliable stabilisation, with the approach chosen according to the pattern and alignment. Large prospective studies confirm that decompression with appropriate stabilisation improves myelopathy. The balanced view is that posterior cervical fusion is a well-established, effective technique where stability and alignment need to be secured, used as part of an individualised plan.

The operation is performed under general anaesthetic, usually with a hospital stay of a few days. The metalwork provides immediate stability, while the fusion consolidates over the following months. Where the cord has been decompressed, neurological recovery typically occurs gradually, and rehabilitation supports recovery. Some reduction in neck movement is expected across the fused levels. As with any operation there are risks, which are discussed fully beforehand. The best approach for a given person is decided together.

• —Fehlings MG, et al. Efficacy and safety of surgical decompression in cervical spondylotic myelopathy: AOSpine North America prospective multicentre study. J Bone Joint Surg Am 2013. (PMID 24048552)
• —Yuan W, et al. Laminectomy and fusion versus laminoplasty for multilevel cervical myelopathy: systematic review and meta-analysis. Eur Spine J 2017. (PMID 27342611)
• —Sattari SA, et al. ACDF versus posterior decompression in degenerative cervical myelopathy: systematic review and meta-analysis. J Neurosurg Spine 2023. (PMID 36840737)
• —Avetisian H, et al. Laminoplasty versus laminectomy and posterior fusion for cervical myelopathy: meta-analysis of radiographic and clinical outcomes. Global Spine J 2024. (PMID 38764362)